Psychiatry International

Little is known about the interplay of Gaming Disorder (GD) with psychotic processes in schizophrenia. Only a few clinical cases involving video game playing and psychotic symptoms have been previously reported in literature. This case report describes a 24-year-old male diagnosed with paranoid schizophrenia and GD. Our case, Patient G, had premorbid excessive video game playing and Game Transfer Phenomena (GTP) prior to the onset of his schizophrenia illness. GTP are common among gamers and are characterised by abnormal perceptions, intrusive thoughts, and temporal change on behaviours related to the content of video games. However, GTP are not necessarily of delusional intensity for meeting the threshold of psychosis. The relapse in Patient G’s paranoid schizophrenia was associated with recent cannabis use, social withdrawal, and excessive video game playing. Patient G’s psychotic symptoms were influenced by video game themes and the movie “Matrix”, including the delusion that he was in a video game and that people around him were “non-playable characters”. Awareness of GTP can help clinicians to demarcate GTP from psychotic features and identify their interactions, given the ensuing treatment implications. Our case report highlights the importance of GTP, which in some cases may be an early sign of developing mental illness and could have implications for early intervention and prevention of illness onset and complications. Full article

Background: Problematic internet use (PIU) or internet addiction has become increasingly prevalent, and concerns about its impact on mental health and social functioning have grown. This study aimed to investigate the prevalence of PIU among Syrian university students and its relationship with their demographics, internet user behavior, and mental health. Methods: A cross-sectional study was conducted among undergraduate medical students in Syrian government universities between 12 April and 29 May 2022. The survey included the Beck Depression Inventory and the Internet Addiction Scale. Results: Out of 2891 participants, 75.2% were female, with an average age of 21.87. The average Internet Addiction Test (IAT) score was 49.4, and the overall prevalence of PIU was 89%. Furthermore, 93.0% of participants displayed possible signs and symptoms of depression. PIU was significantly linked with physical abuse (p = 0.001) and mental stress (p = 0.0001). Internet addiction is (AOR:1.723, COR:2.289) fold more likely to occur in those with more than 8 h of sleep per night than in those who sleep for less than 6 h (p-value < 0.05). Unadjusted regression analysis showed that 13 predictors of the independent variables were statistically significant in predicting the presence of internet addiction, such as participants who suffered from a breakup (COR:2.039), domestic violence (COR:2.136), physical abuse (COR:2.190), or mental stress (COR:2.621) were more likely to be affected by internet addiction than those who did not (p-value < 0.05). Conclusions: The study found a high rate of internet addiction among Syrian medical students, with those experiencing mental health problems and depression symptoms more likely to be internet addicts. To prevent PIU, students should be encouraged to participate in extracurricular activities, such as sports, and awareness programs should be enhanced to highlight the negative effects of internet addiction. Full article

The psychological reproduction of cocaine’s ability to increase happiness was studied. The first part of this study consisted of building and validating an instrument to measure the stable and transient aspects of happiness via the 10-item Happiness Trait–State Scale (10 HTSS) in a sample of volunteers (N = 128). In the second part, Self-Regulation Therapy (SRT, a procedure based on suggestion and classic conditioning) was applied to all the participants to increase their relaxation during a single session. The relaxation session slightly increased happiness. A subgroup of participants who were cocaine users (N = 33) took part in a second session to reproduce the stimulant and euphoric cocaine effects. That was a “mental” reproduction session to simulate the effects of cocaine. For both conditions, all the participants filled in the 10 HTSS at the beginning and the end of the session to compare scores and to prove if the happiness state increased. For the cocaine condition, happiness markedly increased, especially in comparison to the increase during the relaxation session, for both the total group and the cocaine users group. Although this increase was achieved during a single session, similar previous studies with more continuous training and monitoring suggest that improvement in emotions can be durable and long term. Full article

Objective: This report aims to compare the effectiveness between electroconvulsive therapy (ECT) and transcranial direct stimulation (tDCS) among patients with treatment-resistant depression (TRD) and the associated factors. Methods: This was a secondary data analysis of a randomized, controlled, open-label trial conducted from 1 July 2018, to 31 December 2018. The dataset of 90 patients included in the study was retrieved from Mendeley Data. Patients with TRD were randomized 1:1 into either receiving ECT or tDCS. A good treatment response was determined as an improvement from the Hamilton Depression (HAM-D) baseline score at a rate of more than or equal to 50% at the end of a 2-week intervention. A mixed-effect logistic regression was performed to explain the hierarchical data structure of predictors to successful treatment outcome. Results: The largest magnitude of change was consistently observed in the ECT treatment arm across both HAM-D score and the clinical global impression severity scale (CGI-S) scale (p < 0.001). Lower baseline HAM-D scores (OR: 0.72, 95% CI: 0.58, 0.92), lower baseline CGI-S scale (OR: 0.30, 95% CI: 0.17, 0.55), and ECT as the choice of treatment modality (OR: 14.0, 95% CI: 5.08, 38.58) independently predicted successful therapy among TRD patients, while modelling with multiple logistic regression determined that low socio-economic status (aOR: 20.01, 95% CI: 1.89, 211.47), ECT (aOR: 31.7, 95% CI: 6.32, 159.0) and a lower baseline CGI-S scale (aOR: 0.18, 95% CI: 0.06, 0.57) were significantly predictive of a positive treatment outcome among patients with TRD. Conclusions: ECT was more effective in alleviating depressive symptoms in TRD as compared to tDCS. Full article

Background: Individuals with intellectual developmental disability (IDD) often face barriers in accessing dental care. The main aim of the present study was to test the feasibility and the outcome of oral hygiene (OH) procedures in Rett syndrome (RS) patients, and a secondary aim was to test the utility of music therapy during dental hygiene procedures. Methods: A case group (Group 1) of female patients with RS (stage 3 of disease, age > 5 years and <18 years) and a control group of age-matched healthy females (Group 0) were formed, and subgroups received the intervention of oral hygiene combined with a music therapy (Subgroup 1M and Subgroup 0M) or standard oral hygiene (subgroup 1W and subgroup 0W). The Simplified Oral Hygiene Index (OHI-S) was used to assess the effectiveness of oral hygiene measures. Results: The OHI-S at T0 was 1.41 in Group 1 and 2.58 in Group 0 (p value < 0.001). The mean duration of the oral hygiene treatment was 7018″ (SD 3272″) in Group 1 and 873″ (SD 161″) in Group 0 (p value < 0.001). The mean duration of OH was significantly higher in Subgroup 1M and Subgroup 0M. Discussion: Based on the results of our case-control study, OH procedures can be successfully performed in RS patients with good compliance and efficacy. In addition, our study provides preliminary evidence to suggest that music therapy may be a useful adjunct, as it appears to improve patient cooperation. Full article

Background of the study: Depression is a prevalent mental disorder characterized by various symptoms, including low mood, lack of pleasure, changes in appetite and sleep, and difficulty concentrating. Antidepressants are commonly used to manage depression as well as other related disorders, such as anxiety and somatoform disorders. This study aimed to investigate the adverse drug effects experienced by adult patients who were using antidepressants at Chitwan Medical College Teaching Hospital in Nepal. Methods: This study was a retro-prospective, observational study consisting of 117 adult patients under antidepressant medication. The adverse drug profile for the patients was collected using an antidepressant side effect checklist developed by the NHS foundation trust. Statistical analysis was performed using SPSS version 20. Result: The study group consisted of adult patients using antidepressants at Chitwan Medical College Teaching Hospital, Chitwan, Nepal. The mean age of the group was 40.9 ± 12.8, with 63.2% females and 36.7% males. The most common conditions for which antidepressants were prescribed were depression (49.5%), anxiety disorder (31.6%), and somatoform disorder (13.6%). Amitriptyline was the most commonly used medication in monotherapy (64.1%), followed by escitalopram and sertraline. Dry mouth, weight gain, drowsiness, blurred vision, problems with sexual function, and an increase in appetite were the most commonly reported adverse effects. The incidence of certain adverse effects was higher in the multiple therapy group than in the monotherapy group (p < 0.05). Conclusion: The incidence of adverse drug effects is high in patients taking antidepressants, especially those receiving multiple medications. Educating patients about common side effects and prescribing monotherapy whenever possible are crucial in reducing the incidence. Full article

The first postpartum year presents threats to the mental health of birthing parents and obstacles to accessing care. Digital mental health interventions (DMHIs) hold potential to increase postpartum mental healthcare access. However, DMHIs tend to promote limited engagement particularly when they are self-guided (when they do not involve contact with a provider). Yet, given that provider support is a limited resource, a balance must be struck between accessibility and intervention intensity (i.e., involving more human contact). Towards achieving this balance, this analysis seeks to identify characteristics that are associated with a reported preference for a human-guided introduction to digital resources aimed at promoting postpartum mental health. In a sample of largely White, non-Latinx, employed, married, and graduate school-educated individuals, multivariate logistic regression revealed that age (p = 0.0095), level of postpartum functioning (p = 0.0057), depression symptoms (p = 0.0099), and anxiety symptoms (p = 0.03) were associated with guide preference. Specifically, more anxious or lower-postpartum-functioning individuals were more likely to report preferring a guide while older or more depressed individuals were less likely to report preferring a guide. These findings can inform clinical recommendations surrounding who is most likely to engage with, and thus benefit from, exclusively self-guided DMHIs during the postpartum period. Full article

Introduction: A positive association between Internet usage time and Internet addiction among adolescents and adults has been frequently reported; however, studies of working adults focusing on weekdays and holidays are limited. Therefore, this study aimed to elucidate the association between Internet usage time and psychometric tests among working adults in their 30s, focusing on weekdays and holidays. Methods: A total of 129 workers aged 30–39 years participated in this study. Participants completed a questionnaire and interview regarding psychometric tests, including Internet usage time, Internet addiction tendency, smartphone addiction tendency, depression tendency, and personality traits. A correlation analysis focusing on differences between weekdays and holidays was conducted. Results: The scores on Internet addiction scales are weakly positively correlated with holiday Internet usage time. The scores of smartphone addiction scales are also weakly positively correlated with the holiday Internet time. No correlation was found between weekdays Internet usage time and scores on Internet addiction scales. Conclusions: Internet usage time during holidays is associated with Internet addiction tendency among the working adult samples. Holiday Internet usage time could be a useful indicator of risk of Internet addiction. Our pilot findings provide clues to the mental health affected by the Internet, especially among adults. Full article

Aggressive behaviors of people with dementia pose a significant challenge to employees in nursing homes and aged care facilities. Aggressive behavior is a result of psychomotor agitation in dementia (BPSD). Globally, psychotropic interventions are the preferred treatment for BPSD. However, it is still unclear which psychotropic should be prescribed. The purpose of this systematic review is to compare pharmacological interventions for psychomotor agitation and psychosis symptoms. Method: The studies were extracted from databases, such as PubMed, OVID, and Cochrane, with a date restriction from 2000 to present, and in English. PRISMA steps were used to refine the extracted data. The RCTs extracted for this systematic review compared active ingredient medications to one another or to a placebo. Results: PRISMA was used to assess all selected trials comprehensively. Four trials are being conducted on quetiapine, two on haloperidol, one on olanzapine, three on risperidone, one on brexpiprazole, one on pimavanserin, and two on aripiprazole. Compared to typical antipsychotics, quetiapine showed tolerable adverse effects and did not worsen parkinsonism. Psychosis symptoms and behavioral improvements can be improved with haloperidol. Among elderly patients with psychosis, risperidone reduces angriness, paranoia, and aggression, as well as improves global functioning. As compared with other antipsychotics, aripiprazole provides a lower risk of adverse effects and demonstrated improvement in agitation, anxiety, and depression associated with psychosis. While olanzapine improves hostile suspiciousness, hallucinations, aggression, mistrust, and uncooperativeness, it worsens depression symptoms. Psychosis was treated effectively with pimavanserin without adverse effects on motor functions. Psychosis symptoms are well tolerated by brexpiprazole, but insomnia, headache, and urinary tract infections are common side effects. Conclusions: In this systematic review, we provide an overview of how to choose the correct antipsychotics and dosages for the management of BPSD and emphasize the importance of safe and conservative use of these drugs. Full article

Sexual dysfunctions are common among females with common mental health conditions, such as anxiety and depression. However, discussion on this topic remains taboo in many cultures, including India. Worldwide, the Female Sexual Function Index (FSFI) is the most used tool to evaluate sexual functioning in females. Researchers across the globe attempted to translate and validate this scale in native languages (e.g., Japanese and Spanish); however, such translations are not available in Hindi. Strikingly, although there is literature informing us about the regional validation process of this scale, little has been discussed about qualitative nuances of the process of translation, the expert panel discussion, and cognitive interviewing during pilot testing. The lack of such procedural qualitative data limits the replicability of such translations in different cultures; furthermore, it can adversely influence the parameters of the validation study. Hence, the current study was conducted to highlight the process of Hindi translation of the FSFI and illustrate the challenges faced at various stages of translation and testing. The study was conducted in the multidisciplinary hospital of Central India by involving five translators, five expert panel discussants, and 15 patients with common mental health conditions or their caregivers. The significant findings of the current work include the requirement of semantic and grammatical changes and rephrasing of the sentences for improving comprehensibility and applicability in the Indian population (during the panel discussion). Additionally, it informed us to use alternate or more than one word to capture a concept, including English words written in Hindi (during preliminary pilot testing). Critical roadblocks were inadequate awareness of the issues, lack of typical/comprehensive terminologies to capture the ideas, and significant stigma attached to the subject. Full article

Background: Major Depressive Disorder is a leading cause of disability worldwide and one of the most common disorders in the United States. Contributors to an individual’s risk for experiencing depressive disorders include individual and social factors. Although the social determinants of health (SDOH) are conditions that contribute to healthy functioning, health outcomes, and quality of life, it is unclear to what extent adverse SDOH experiences are associated with self-reporting depressive disorder (DD). Methods: Data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey of noninstitutionalized U.S. adults, was employed in this study. Lifetime diagnosis of DD was self-reported among survey participants who also completed the Social Determinants of Health optional module within 17 participating BRFSS states and entities. Rao-Scott chi-square analysis was used to determine the association of individual and SDOH measures with DD. Results: The prevalence of DD among participating states was 19.85%. Among respondents, significant proportional differences were observed for each SDOH indicator regarding DD status. However, significant differences in health insurance coverage were not observed. Conclusion: Survey respondents with a lifetime diagnosis of DD experienced adverse SDOH conditions in greater proportion than individuals not reporting DD. Individual and community-based approaches to address the contextual influences of depressive disorders should be aggressively implemented. Full article

Background: There is clear evidence showing an increase in mental health symptoms along with an increased demand for mental health services since the start of the COVID-19 pandemic. Objective: This study aimed to determine the rates of elevated anxiety symptoms in children during the COVID-19 pandemic in the state of Qatar. It also explored any correlated factors. Method: A cross-sectional, questionnaire-based study with 199 participants (children aged 6–16 years) consulting a dental care center. We used the original English version as well as a previously validated Arabic version of the Parent Spence Children’s Anxiety Scale to measure anxiety symptoms. Results: A total of 29.6% (n = 59) of our sample met the respective elevated cut-off score for overall anxiety disorder. The largest group among the children was elevated levels of physical injury fears 37.6% (n = 75), followed by Social Phobia 36.1% (n = 72). Younger children showed significantly higher scores for total anxiety, separation anxiety, physical injury fears, and generalized anxiety score. Among the gender groups, females reported significantly higher scores of General anxiety disorder. When comparing natives to expatriates, expatriates showed higher scores for total anxiety, physical injury fears score, social phobia score, and generalized anxiety. Conclusions: Overall, this study shows increased rates of clinically elevated anxiety symptoms in children during the COVID-19 pandemic in the state of Qatar. Younger children, females, and expatriates were more vulnerable to the psychological impact of the COVID-19 pandemic. This study highlights the specific psychological vulnerability of this population group during major health crises like the current pandemic. Full article

Miscarriage or perinatal loss constitutes one of the most important emotional stressors a woman can experience and can be associated with bereavement. This mourning is a way of adapting and coping with the circumstances. However, inadequate management of this process can lead to the development of complicated grief and psychopathologies such as anxiety, depression, and post-traumatic stress disorder. The aim of this systematic review was to evaluate the prevalence of psychopathology (anxiety, depression, and post-traumatic stress disorder) in women with a history of miscarriage or perinatal loss in the year prior, and to compare these results with women without this history. A peer review was conducted in PubMed, Cochrane, Scopus, and Web of Science databases. We included (1) articles that included women of any age who had had a miscarriage or perinatal loss in the year prior, and (2) articles with a longitudinal cohort design with a comparison group of women without a history of miscarriage or perinatal loss. After the screening process, three articles met these inclusion criteria and were included in this study. Psychopathology in women after miscarriage or perinatal loss was higher than in the control groups. In addition, it was observed that these psychopathologies gradually decreased over the first year from the loss. In conclusion, abortion and perinatal loss pose a risk factor for the development of psychopathology. Therefore, we emphasize the importance of implementing a mental health plan for these women. Full article

This study aims to analyze the main and most recent forms of gambling and related psychopathological disorders, also proposing psychological clinical recommendations. From November 2022 to February 2023, we searched the databases of PubMed, Web of Science, Health & Medical Collection, Elsevier Journal, and Springer for relevant studies performing different searches through different search strings. New forms of gambling are mostly related to new technological tools, such as the Internet, smartphones, social media, or electronic machines. The prevalence of online gambling affects all demographic groups, although 35–44-year-olds appear to have the largest share. Online gambling can lead to addiction, financial hardship, and mental health problems. It has also been statistically significantly associated with high levels of Gambling disorder, high levels of depression and anxiety, poor overall mental health, and alcohol use. Furthermore, it has been noted that online gamblers are more likely to engage in high-risk gambling behaviors and have a higher prevalence of comorbid mental disorders. The review highlights the need for continued research on the impact of new forms of gambling and the development of effective prevention and treatment strategies. Further research is needed to better understand the complex relationship between new forms of gambling and the development of gambling disorders. Full article

The study of wording and its impact on medical practice is key for the training of future physicians. Negative, imprecise, and disrespectful terms are still widespread in the medical field and contribute to the stigmatization of people in treatment, which ultimately limits their access to care. In this study, we explore the feasibility and acceptability of a method to investigate medical students’ perceptions of wording and stigma. This method involves a questionnaire that medical students complete after having read a clinical vignette. One of the two versions of the vignette is made available, which only varies in the way the patient is referred to (“substance abuser” vs. “having a substance use disorder”). Medical students from the University of Lausanne between their first and sixth year were contacted via the university’s mailing lists. They were randomly exposed to one of the two versions of the vignette and responded to the questionnaire online. This exploratory study shows that it is feasible and acceptable to assess the influence and perceptions of stigmatizing terminology among students through a vignette-based questionnaire comparing two wording options. In line with the initial study, we find trends in favor of the non-stigmatizing terminology; however, beliefs are widely held about the need for judicial “punishment” to address consumption behavior. No statistically significant differences are found between the two groups. The study of wording and its impact on access to care is a crucial issue which seems necessary to integrate into pre-graduate training. It permits the deconstruction of prejudices related to medical knowledge and offers perspectives for intervention and research to improve the right to health, which includes the fundamental right to access to care. Full article

This quasi-experimental study aimed to investigate how rational emotive behavior therapy (REBT) works in Indonesian outpatient settings, especially in the context of the COVID-19 pandemic. This study evaluated depression, anxiety, and sleep among 60 Atma Jaya Hospital patients (public and private) using several assessment tools (PHQ-9, GAD-7, and PSQI). The majority of participants were under 40 (53.3%), female (58.3%), married (56.6%), and working formally (65%), with either high school or diploma/bachelor’s level education (86.6%). After six REBT therapy sessions, significant improvements were evident in anxiety, depression, and sleep quality scores (p < 0.001). Participants showed improvements in anxiety and depression during the third and sixth sessions; and in sleep quality during the sixth session. These findings suggest that REBT-based interventions are effective in public and private outpatient settings, highlighting the importance of psychotherapy and cross-division collaboration in the Indonesian healthcare system. Full article

Intolerance of Uncertainty (IU) is described as the tendency to avoid uncertain states and exhibit negative responses to uncertain situations on cognitive, emotional, and behavioral levels. It is considered a transdiagnostic cognitive bias that plays a role in developing and maintaining psychopathology. The Intolerance of Uncertainty Scale-12 (IUS-12) has proven to be a sound measure of intolerance of uncertainty with excellent validity and reliability. Although research has supported a two-factor structure of IUS-12, most recent studies also suggest a bifactor model. The present study examines the factorial structure, validity, and reliability of the Greek version of IUS-12 with a sample of 959 university students (66.6% female) aged 19.63 years (SD = 3.20). Confirmatory Factor Analysis showed that although the two-factor solution adequately fit the data, the bifactor model better fit with IU total as an underlying one-factor. Internal consistency and validity were excellent for the total IUS-12 and Prospective and Inhibitory Anxiety subscales. Our findings support recent findings concerning the factorial structure of IUS-12 and the scale’s psychometric qualities in a Greek undergraduate sample. We expect that future research with clinical samples will confirm the screening and clinical utility of IUS-12. Full article